Renaming schizophrenia
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39057.662373.80 (Published 18 January 2007) Cite this as: BMJ 2007;334:108
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The discussion on Lieberman and First’s (1) editorial appears to be
mainly focused on the semantic level (is the old term “schizophrenia”
consistent with our current understanding of this pathological condition?)
and on the pragmatic level (would renaming schizophrenia be of significant
and long-term help for destigmatisation purposes?).
However, another problem appears particularly important: is schizophrenia
a disease in its usual Western sense, namely a natural entity with a known
pathophysiology explaining its symptoms and allowing a differential
diagnosis from other diseases? Scientists working within the framework of
the neo-kraepelinian research program introduced operational criteria in
an attempt to improve reliability. They believed that this was the first
step in order to enucleate valid disease entities with distinct boundaries
whose underlying etiology would be later discovered (2). What is now clear
is that “in the more than 30 years since the introduction of Feighner
criteria by Robins and Guze, which eventually led to the DSM-III, the goal
of validating these syndromes and discovering common etiologies has
remained elusive” (3). Accordingly, the current categorial classification
entered a period of crisis and revolutionary systems of classification are
waited (4,5). In this context it is not surprising that schizophrenia does
not represent a single disease entity (it was a group of conditions since
the beginning (6)), that its boundaries are unclear and that we cannot
reasonably expect to find a unique etiology underlying all cases.
Lieberman and First (1) acknowledge the diagnostic limits of the concept
of schizophrenia, nevertheless they continue to adhere to the neo-kraepelinian research program and to think about schizophrenia as a brain
pathology. Similarly, Ahuja and Cole (7) correctly argue against the
possible name “dopamine dysregulation disorder” but they write that it is
so because there is more than dopamine that is dysregulated in
schizophrenia, stressing “a peril of plethora of names emerging for the
same condition”. But it is this the most problematic point: schizophrenia
is not a disease but a general label under which many different clinical
conditions are probably subsumed. Therefore the key point is not to give a
new name to schizophrenia but to reverse our research agenda: we should
not start from the diagnosis of schizophrenia to test etiological
hypotheses, because it is unlikely that a common brain pathology may be
discovered starting from a heterogeneous and “fuzzy-boundaries” category.
On the contrary, it would be preferable to start from known specific
functional abnormalities and then try to explain the pathophysiological
mechanisms linking these abnormalities to emerging symptoms (4). If
research succeeds in achieving this aim the classical schizophrenia would
be progressively dismembered in new entities and the problem of changing
its name will naturally disappear.
1. Lieberman JA, First MB. Renaming schizophrenia. BMJ 2007; 334:
108.
2. Klerman GL. A debate on DSM-III: the advantages of DSM-III. Am J
Psychiatry 1984; 141: 539-542.
3. Kupfer DJ, First MB, Regier DA. Introduction. In: DJ Kupfer, MB
First, DA Regier (eds) A research agenda for DSM-V, pp XVIII. Washington
DC: American Psychiatric Association, 2002.
4. Aragona M. Aspettando la rivoluzione. Il DSM-V e oltre: le nuove
idee sulla diagnosi tra filosofia della scienza e psicopatologia. Roma:
Editori Riuniti, 2006.
5. Aragona M. A bibliometric analysis of the current status of
psychiatric classification: the DSM model compared to the spectrum and the
dimensional diagnosis. It J Psychopat 2006; 12: 342-351.
6. Bleuler E. Dementia praecox: or the group of schizophrenias.
(trans. By J. Zinkin). New York: International Universities Press, 1950.
7. Ahuja N, Cole AJ. What’s wrong with the term “Schizophrenia”?
Rapid response to Lieberman and First.
http://www.bmj.com/cgi/eletters/334/7585/108
Competing interests:
None declared
Competing interests: No competing interests
Since people seem more comfortable talking about Alzheimer's Disease
as opposed to Dementia, wouldn't be a stroke of genius to simply call
schizophrenia Bleuler's Disease? After all, Bleuler is particularly
notable for naming schizophrenia; a germanic name with an exotic
provenance and particular pronunciation may be all what is needed in a
nationwide (worldwide?) PR exercise...
Competing interests:
None declared
Competing interests: No competing interests
In their editorial defending the ‘schizophrenia’ concept, apparently
sparked by a press conference at which one of us participated, Professors
Lieberman and First recycle some enduring myths about psychiatric
diagnoses.
Here are some of the myths. Lieberman and First assert that, “Many
studies have shown that these diagnostic criteria [for ‘schizophrenia’]
can be applied reliably and accurately”. However, the accuracy of a
diagnosis can only be determined if there is an absolute benchmark to
compare it against. Moreover, agreement between different operational
definitions of schizophrenia is poor (in the UK 700 study the number of
‘schizophrenia’ patients varied between 268 and 387 according to whether
RDC, DSM-III-R or ICD-10 definitions were used [1]); and clinicians using
the same criteria show poor agreement if they use different methods of
interviewing patients [2]. Lieberman and First say, “Schizophrenia is not
caused by disturbed psychological development or bad parenting” but there
is compelling evidence that being unwanted at birth [3] , early separation
from parents [4], sexual abuse [5-7] and other kinds of adverse family
relationships [8] all increase the risk of psychosis in adult life. Nor
is it true that, “abnormalities in brain structure and function seen on
neuroimaging and electrophysiological tests” establish the reality of
‘schizophrenia’ as a biological disorder, as diverse neurobiological
findings have been reported in ‘schizophrenia’ patients, as many brain
abnormalities are not specific to the diagnosis [9], and as animal and
human studies have shown that adverse early experience can lead to
profound changes in brain structure and function of the kind seen in
patients [10, 11]. The claim that “the evidence that vulnerability to
schizophrenia is at least partly genetic is indisputable” is undermined
when it is noted that methodological biases in the behavioural genetics
literature have led to over-estimation of the heritability of the
diagnosis [12], that no genes of major effect for ‘schizophrenia’ have
ever been discovered, and that those genes of minor effect that have been
identified also confer vulnerability to other diagnoses [13]. Finally,
Lieberman and First’s implication that a diagnosis of 'schizophrenia' is
useful in guiding treatment makes no sense when it is realised that
relapse is better predicted by psychosocial than psychopathological
variables [14] and that responses to psychiatric medications are not
predicted by diagnosis [15]. Indeed, it is often forgotten that the
therapeutic effect of the antipsychotics was first demonstrated on manic
patients [16].
In the seventeenth century, the Roman Catholic Church asserted that
the Earth was the centre of the Universe but this did not make it so. The
assertion by members of the medical-pharmaceutical establishment that
'schizophrenia' is a useful concept does not make it so either. The
results of continuing with the old assumptions about mental illness are
plain for all to see. After 100 years of research on ‘schizophrenia’,
researchers have not provided us with a single biological marker of
diagnostic value. The promotion of biological models of psychosis, far
from reducing the stigma experienced by patients, has increased it [17].
The outcomes for psychotic patients have not improved [18, 19] and the
number of people suffering from enduring psychiatric disability has
increased [20]. Patients in third-world countries do better than those in
the industrialised world who avail themselves of modern psychiatric
services [21]. Meanwhile, new and expensive antipsychotic drugs are
marketed as better than the old ones although they are no better in
reality [22, 23]; their main beneficiaries seem to be drug company share-
holders.
Psychosis should be seen on a continuum with normal experience, and
biological findings should be integrated with observations from psychology
and the social sciences [24]. Care should be offered on the basis of
patients’ needs and strengths rather than diagnosis. What is needed is no
less than a revolution in our scientific approach to understanding severe
mental illness, paralleled by a humane revolution in the way we try and
help some of the most vulnerable and disadvantaged members of our society.
1. van Os, J., et al., A comparison of the utility of dimensional and
categorical representations of psychosis. Psychological Medicine, 1999.
29: p. 595-606.
2. McGorry, P.D., et al., Spurious precision: Procedural validity of
diagnostic assessment in psychotic disorders. American Journal of
Psychiatry, 1995. 152: p. 220-223.
3. Myhrman, A., et al., Unwantedness of preganancy and schizophrenia in
the child. British Journal of Psychiatry, 1996. 169: p. 637-640.
4. Morgan, C., et al., Parental separation, loss and psychosis in
different ethnic groups: A case-control study. Psychological Medicine,
2006.
5. Bebbington, P., et al., Psychosis, victimisation and childhood
disadvantage: Evidence from the second British National Survey of
Psychiatric Morbidity. British Journal of Psychiatry, 2004. 185: p. 220-
226.
6. Janssen, I., et al., Childhood abuse as a risk factor for psychotic
experiences. Acta Psychiatrica Scandinavica, 2004. 109: p. 38-45.
7. Read, J., et al., Sexual and physical abuse during childhood and
adulthood as predictors of hallucinations, delusions and thought disorder.
Psychology and Psychotherapy: Theory, Research and Practice, 2003. 76: p.
1-22.
8. Wahlberg, K.E., et al., Thought disorder index of Finnish adoptees and
communication deviance of their adoptive parents. Psychological Medicine,
2000. 30: p. 127-136.
9. Geuze, E., E. Vermetten, and J.D. Bremner, MR-based in vivo hippocampal
volumetrics: 2. Findings in neuropsychiatric disorders. Molecular
Psychiatry, 2005. 10: p. 160-184.
10. Read, J., et al., The contribution of early traumatic events to
schizophrenia in some patients: A traumagenic neurodevelopmental model.
Psychiatry: Interpersonal and Biological Processes, 2001. 64: p. 319-345.
11. Selten, J.-P. and E. Cantor-Graae, Social defeat: Risk factor for
psychosis? British Journal of Psychiatry, 2005. 187: p. 101-102.
12. Joseph, J., The gene illusion: Genetic research in psychology and
psychiatry under the microscope. 2003, Ross-on-Wye: PCCS Books.
13. Craddock, N. and M.J. Owen, The beginning of the end of the
Kraepelinian dichotomy. British Journal of Psychiatry, 2005. 186: p. 364-
366.
14. Canive, J.M., et al., Family environment predictors of outcome in
Spaniard schizophrenic patients: A nine-month follow-up study. Acta
Psychiatrica Scandinavica, 1995. 92: p. 371-377.
15. Johnstone, E.C., et al., The Northwick Park 'functional' psychosis
study: Diagnosis and treatment response. Lancet, 1988. ii: p. 119-125.
16. Swazey, J.P., Chlorpromazine in psychiatry: A study of therapeutic
innovation. 1974, Cambridge, Mass: MIT Press.
17. Read, J., et al., Prejudice and schizophrenia: A review of the 'mental
illness is an illness like any other' approach. Acta Psychiatrica
Scandinavica, 2006. 114: p. 303-318.
18. Healy, D., et al., Service utilization in 1896 and 1996: Morbidity and
mortality data from North Wales. History of Psychiatry, 2005. 16: p. 27-
41.
19. Healy, D., et al., Lifetime suicide rates in treated schizophrenia:
1875-1924 and 1994-1998 cohorts compared. British Journal of Psychiatry,
2006. 188: p. 223-228.
20. Whitaker, R., Anatomy of an epidemic: Psychiatric drugs and the
astonishing rise of mental illness in America. Ethical Human Psychology
and Psychiatry, 2005. 7: p. 23-35.
21. Sartorius, N., et al., Course of schizophrenia in different countries:
Some results of a WHO comparative 5-year follow-up study, in Search for
the causes of schizophrenia, H. Hafner, W.G. Gattaz, and W. Janzarik,
Editors. 1987, Springer: Berlin. p. 909-928.
22. Jones, P.B., et al., Randomized controlled trial of the effect on
quality of life of second- vs first-generation antipsychotic drugs in
schizophrenia. Archives of General Psychiatry, 2006. 63: p. 1079-1087.
23. Lieberman, J.A., et al., Effectiveness of antipsychotic drugs in
patients with chronic schizophrenia. New England Journal of Medicine,
2005. 353: p. 1209-1223.
24. Bentall, R. P. Madness explained: Psychosis and human nature.
2003. London: Penguin Press
Competing interests:
None declared
Competing interests: No competing interests
Dear Dr. Godlee,
Re: Renaming schizophrenia: the need for evidence
We share the caution of Lieberman and First 1 in their leader about
renaming schizophrenia. The stigma and discrimination of people given the
diagnosis of schizophrenia are grave and influence the quality of their
life as well as the course and outcome of the disease 2 3. In other
domains of medicine there are numerous examples of name changes which were
intended to make a condition more speakable, for example, Hansen’s disease
(leprosy), or Down’s syndrome (‘mongolism’), which has changed name
repeatedly over the last century without clear data on whether this has
been beneficial 4. These debates are rarely illuminated by evidence.
We have recently co-ordinated the INDIGO (International Study of
Discrimination and Stigma Outcomes) Study. In 28 countries across the
world (full details are available from GT) face to face interviews were
completed with 736 people with a clinical diagnosis of schizophrenia. The
main purpose of the study was to assess anticipated and experienced
discrimination. Several questions related to the name of the condition. In
reply to the question ‘Do you know what diagnosis your doctor has made?’
83% answered yes. To the question ‘Do you agree with the diagnosis?’; 72%
agreed, 17% disagreed and 10% were unsure. For the question ‘How much has
it been an advantage or disadvantage for you to have the specific
diagnosis of schizophrenia?’ 54% reported disadvantage, 26% advantage (eg
in directing them information on the condition, or to a self-help group),
and 18% reported no difference.
It is also notable that after the renaming of schizophrenia in Japan
the proportion of such people who were told the name of their condition
increased from 8% to 60% 5. Nevertheless a change of name should not
happen alone: it would be of central importance to introduce a number of
changes into the legislation, services and education of professionals and
of the public if we wish to improve the way in which people with
schizophrenia have to live. Changing the name of schizophrenia would in
that instance probably be beneficial because it would be an indicator of
change rather than the change. In particular, before initiating far-
reaching changes in psychiatric terminology it is vital to have clear
evidence of any benefit, particular from the perspective of people with
schizophrenia.
Graham Thornicroft, Norman Sartorius, Diana Rose and Elaine Brohan.
References
(1) Lieberman JA, First MB. Renaming schizophrenia. BMJ 2007;
334(7585):108.
(2) Sartorius N, Schulze H. Reducing the Stigma of Mental Illness. A
Report from a Global Programme of the World Psychiatric Association.
Cambridge: Cambridge University Press; 2005.
(3) Thornicroft G. Shunned: Discrimination against People with Mental
Illness. Oxford: Oxford University Press; 2006.
(4) Jain R, Thomasma DC, Ragas R. Down syndrome: still a social stigma. Am
J Perinatol 2002; 19(2):99-108.
(5) Kim Y, Berrios GE. Impact of the term schizophrenia on the culture of
ideograph: the Japanese experience. Schizophr Bull 2001; 27(2):181-185.
Competing interests:
None declared
Competing interests: No competing interests
Lieberman & First justify the concept of schizophrenia as brain pathology.1 However, they admit that the cause of the disorder and the precise pathophysiology are unknown.
Operational diagnostic criteria were introduced in an attempt to improve the reliability of psychiatric categories, such as schizophrenia.2 Despite what Lieberman & First say, the genetic basis of schizophrenia can be challenged.3 It is not clear why they dismiss disturbed psychological development and parenting as factors in aetiology. Nor what abnormalities in brain structure and function they think have been demonstrated on neuroimaging and electrophysiological tests.
The question is whether schizophrenia is an improvement over the mere description of psychotic symptoms. Eugene Bleuler introduced the term in 1911 as an advance over Emil Kraepelin's notion of dementia praecox, as not all schizophrenic patients are "victims of deterioration early in life".4 Bleuler regarded schizophrenia as a functional disorder, although he could not exclude the possibility of "certain mild organic disturbances". He believed it was a disease, which did "not permit a full restitutio ad integrum", and that it was demarcated by the presence of fundamental symptoms which occur only and always in schizophrenia representing "a more or less clear-cut splitting of the psychic functions".
Few would now accept this Bleulerian understanding of schizophrenia. And yet the term survives. This is more in the Kraepelinian rather than Bleulerian sense. What is needed is a biopsychological understanding of schizophrenia.5 The danger of focusing on schizophrenia as a biomedical diagnosis is that it may avoid understanding of the person by reducing mental health problems to brain pathology. The justification for retaining the concept of schizophrenia is that it seems to provide some organisation to the classification of psychosis, not because it points to an underlying brain abnormality.
- Lieberman JA, First MB. Renaming schizophrenia. BMJ 2007; 334:108. (20 January 2007) [Full text]
- Blashfield, R.K. The classification of psychopathology. Neo-Kraepelinian and quantitative approaches. New York: Plenum, 1984
- Joseph J. The gene illusion. Genetic research in psychiatry and psychology under the microscope. Ross-on-Wye: PCCS books, 2003.
- Bleuler E. Dementia praecox: or the group of schizophrenias. (trans. by J. Zinkin). New York: International Universities Press, 1950
- Double DB. The biopsychological approach in psychiatry: The Meyerian legacy. In DB Double (ed) Critical psychiatry: The limits of madness, pp 165-87. Basingstoke: Palgrave Macmillan, 2006.
Competing interests:
None declared
Competing interests: No competing interests
Lieberman & First1 argue that schizophrenia should not be renamed
as it is a valid diagnostic category, it has many treatment options with a
sound evidence base and there are valid and reliable diagnostic criteria.
These assertions would not be disputed by the vast majority of those
working in mental health services. These are reasons, though, to keep the
diagnostic category rather than the name of it unchanged. They are quite
correct that the name is less important than its diagnosis or treatment.
However, many patients and carers are unhappy with the name.2
The main problem with the name, schizophrenia, is not that it is
‘politically incorrect’ but just incorrect. The concept of a ‘split mind’
is not supported by scientific advances and it is therefore unhelpful to
apply this concept to people with the disorder any more. The argument
that the name of a diagnosis has stood the test of time is no reason not
to modernise it. For example, in the ICD-10 the diagnosis of hysteria has
been replaced by categories of dissociative or conversion disorders.3 In
the UK the term mental handicap has been changed to learning disability by
the Royal College of Psychiatrists and the new term is now in popular
usage. Schizophrenia should not be exempt from the same processes.
Other interesting evidence that informs the debate about a possible
name change for schizophrenia comes from psychiatrists. According to
Clafferty et al4, psychiatrists don’t tell their patients the diagnosis
frequently enough. In a postal questionnaire they found only 59% of
psychiatrists informed their patients of a diagnosis of schizophrenia
after a first episode, and 15% said they would not use the term
schizophrenia. Moreover, 43% stated they felt uncomfortable about it and
10% felt it may harm the therapeutic alliance. In my own research, I
found further evidence that psychiatrists are cautious about telling a
patient their diagnosis of schizophrenia. In this qualitative study of
psychiatrists’ views about their practices, some stated that they opted to
preserve the therapeutic alliance by finding common ground or
circumventing the diagnosis, tried to minimise the impact of symptoms, and
exercised considerable judgement about the exact language and timing of a
discussion of diagnosis.5
It should be acknowledged that the stigma associated with
schizophrenia would not be abolished by a name change. This is supported
by a Chinese study.6 Students did not display any less stigmatising
attitudes to a vignette of a person with schizophrenia whether give a
diagnosis of schizophrenia, an alternative diagnosis or no diagnosis.
Conversely a label of schizophrenia generated more positive attitudes
amongst students with religious beliefs.
The issue of stigma is further complicated by patient’ own internal
working models. There can be a perception of stigma by people with mental
illness in addition to the actual attitudes expressed by other people.
This can lead to psychiatrists avoiding the term so as not to stigmatise
their patients. The avoidance of the term schizophrenia can lead to
alternative terms being adopted by patients and psychiatrists. Examples
are ‘Neuro Biochemical Disorder’ adopted by a patient2 and psychosis
commonly used by clinicians. It is therefore necessary to review all the
evidence for and against a name change rather than altogether rejecting
the idea or adopting an over zealous attitude to change.
The final difficulty is that schizophrenia describes a
characteristic, although very diverse, pattern of symptoms. This is in
contrast to the diagnoses of anxiety states, mood disorders, eating
disorders and learning disability where a central theme is generally
present with people who have the conditions. There is no obvious new
name, as illustrated by the many different names suggested by clinicians
and service users: the survey of names suggested by service users
described2 identified over 120 different ones. The participation of
people with schizophrenia is central to the debate about a possible name
change.
References
1. Lieberman JA, First MB. Renaming schizophrenia: Diagnosis and
treatment are more important than semantics. BMJ 2007;334:108
2. Berg SZ. Changing the S word: is there a better name?
Schizophrenia Digest 2006;Fall:30-34
3. World Health Organization ICD-10 Classification of Mental and
Behavioural Disorders. Geneva, Switzerland: World Health Organization,
1992
4. Clafferty RA, McCabe E, Brown K. Telling patients with
schizophrenia their diagnosis. Psychiatric Bulletin 2001;25:336-339
5. Chaplin R, Lelliott P, Quirk A, Seale C. Negotiating styles
adopted by consultant psychiatrists when prescribing antipsychotics.
Advances in Psychiatric Treatment 2007;13:43-50.
6. Chung KF & Chan JH. Can a less pejorative Chinese translation
for schizophrenia reduce stigma? A study of adolescents’ attitudes toward
people with schizophrenia. Psychiatry and Clinical Neurosciences
2004;58:507-515
Competing interests:
None declared
Competing interests: No competing interests
The media article cited goes on to prove that the way we perceive
Psychiatry has not changed. Labels or diagnosis in Psychiatry is
inherently stigmatizing and people would prefer to shy away from such a
diagnosis.
Considering the current controversies regarding the biological basis
of the illness, it would be unwise to change the label to something which
we are even more unsure of.
We must always bear in mind that most psychiatry illness are
diagnosed on the basis of symptom clusters rather than a fundamental
biological change. With this view do we still want to change the name of
an illness?
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor
Mental illness attracts attention from lay people or professionals
alike, and rather fortunately or unfortunately, from the media. The
general public always had a concept of madness – and the ICD 10 F20s
diagnosis of Schizophrenia fits well into the same. Whilst the biological
concept appears more prevalent in developed societies compared to the
lesser developed and supernatural believing ones, the general attitude
towards mental symptoms is a negative one. Be it the enduring,
unresponsive nature of the illness or the un-understandable, implausible
symptoms or behaviour. Also, the much highlighted incidents of violence
and attacks by people with mental illness have generated, but very sadly,
a stereotype. Stigma is highly prevalent among people labelled with mental
illness in the community (1).
We agree with the authors Lieberman and First that establishing a
correct diagnosis and then initiating appropriate treatment is much more
important than the name of the illness. The stigma is attached to the
unexplainable presentations of schizophrenia that deviate from the
‘normal’. The stigmatised one at some point does realise this different
status. And this further constitutes a detriment towards return to
‘normalcy’, restriction of social networking (2), social rejection and
self-deprecation (3), impaired functioning and recurrent stress. There is
ample evidence to suggest higher relapse of schizophrenia living in a
hostile and critical environment compared to an accepting one (4).
We also believe that the answer lies in a change of attitude. Public
attitude, corrected through imparting correct information, dispelling
beliefs, stereotypes and fears. The media should as well take on an active
role upon itself, imparting knowledge, preventing stigmatisation and
undoing the incorrect. Even elaborate and definitive steps similar to the
suicide prevention WHO resource for the media professionals may be
necessary (5), which may hopefully establish some guidelines on how to and
how not to report incidents involving the mentally unwell.
And to talk of wrong names and medical incorrectness, malaria still
stands for ‘foul air’.
References:
(1) On stigma and its consequences: evidence from a longitudinal study of
men with dual diagnosis with mental illness and substance abuse. Link BG,
Struening EL, Rahav M et al, 1997. Journal of Health and Social Behaviour
38:177 – 190
(2) Making it crazy: an ethnography of psychiatric clients in an American
community. Estroff S 1981. University of California Press, Berkeley.
(3) From the mental patient to the person. Barham P, Haywood R 1991.
Routledge, London.
(4) Influence of family life on the course of schizophrenic disorders: a
replication. Brown GW, Birley JL, Wing JK 1972. British Journal of
Psychiatry 121: 241 – 258
(5) Preventing suicide: A report for media professionals - Mental and
Behavioural Disorders, Department of Mental Health, World Health
Organization, Geneva 2000
Competing interests:
None declared
Competing interests: No competing interests
One of the arguments in favour of renaming schizophrenia, not
mentioned by Lieberman and First 1, is that the word is a confusing
misnomer 2. Derived from the Greek for “split mind”, it was coined as a
descriptive term in the early twentieth century, when our understanding of
the phenomenon was very different to what it is today.
The semantics would be irrelevant were it not that the word is often
understood by the public as referring to split or dual personality,
suggestive of Jekyll and Hyde characters who are dangerously
unpredictable. We health professionals may be well aware that this is not
a valid description of the relatively common psychotic disorder, but this
is an insight not shared by all.
The word is stigmatising in an unusual way, in that much of the
negative public associations are not a result of the medical usage, but of
the (semantically legitimate) usage in another context altogether. It is
often used by those who wish to criticise perceived inconsistencies in the
behaviour of others. It is difficult to think of the name for any other
medical condition which, as a result of an alternative meaning, is used in
common speech in such a derogatory manner.
The concept of schizophrenia is indeed useful and almost certainly
valid. Unfortunately, in this case, semantics are a problem which should
not be ignored.
1. Lieberman J.A and First M.B. BMJ 2007; 334:108
2. Riordan D.V. “Split personality” and the stigma of schizophrenia.
Irish Journal of psychological medicine 2005; 22(4): 156.
Competing interests:
None declared
Competing interests: No competing interests
Re: Renaming schizophrenia
Schizophrenia has of late become a global concern owing to its debilitating effects on a victim. The fatality of this brain disease has therefore attracted the attention of scientists, as illustrated by the development of the science of neuroimaging. In particular, neuroimaging provides immediate as well as vivid brain images that are then used in discovering key neural bases that subject a person to psychiatric symptoms. Neuroimaging has contributed to the understanding and treatment of schizophrenic disease mechanisms immensely (Winton-Brown & Kapur, 2009).
On this background, this research paper will critically explore how neuroimaging is applied in the clinical practice of diagnosing and treating schizophrenia. The paper will serve as an abstract for further research on the relevance of neuroimaging in schizophrenia treatment.
The science of nueroimaging employs 3D technology to encode anatomical variation patterns, thereby detecting functional alteration patterns in the brains of specific groups. According to Winton-Brown and Kapur (2009), nueroimaging enables the location of the brain areas that are pertinent to schizophrenia, such as the thalamus and the hippocampus. Further, there are certain groups of people that are at a high risk of contracting the disease. From image 3 below, neuroimaging actually facilitates the identification of such groups. The progression rate of schizophrenia can also be monitored through nueroimaging, as exhibited by image 2. Nueroimaging processes like photon emission generate images that reflect how specific brain molecules are distributed (Winton-Brown & Kapur, 2009).
Images generated by neurochemical processes reveal that schizophrenia is a gradual process whose development can be monitored and subsequently stopped. Neurochemical imaging is an excellent technique to use in diagnosing schizophrenia in terms of the likely course along with outcome, disease mechanisms, and response to treatment doses. Consequently, clinicians should embrace neuroimaging besides other diagnostic and treatment procedures in seeking a long-term solution to schizophrenia.
Reference
Allen Istitute for Brain Science. (2010, June 9th). Allen Human Brains Atlas: Mapping Genes in Action. Retrieved September 18th, 2012, from Allen Istitute for Brain Science: http://www.google.co.ke/url?sa=t&rct=j&q=sample%20digital%20atlases%20-%...
Winton-Brown, T. T. and Kapur, S. (2009). Nueroimaging of Schizophrenia: What it Reveals about the Disease and What it Tells us about a Patient. Retrieved September 18th, 2012, from "http://www.annals.edu.sg/pdf/38VolNo5May2009/V38N5p433.pdf"
Competing interests: No competing interests